For people receiving a bilateral lung transplant, the operation is only the beginning of a prolonged period of medical vulnerability. Immunosuppressive drugs are essential for preventing rejection, but they also weaken the immune defenses that normally keep environmental fungi under control. A new safety analysis published in BMC Pharmacology and Toxicology examines the use of liposomal amphotericin B as an antifungal prophylaxis in this high-risk population, focusing on how the treatment can be used while limiting the toxic effects associated with conventional amphotericin formulations.
Fungal infections are a serious concern after lung transplantation because the lungs are continuously exposed to airborne microorganisms. The risk is amplified by surgical injury, impaired mucociliary clearance, intensive immunosuppression, and the presence of airway devices during the early recovery period. Organisms such as Aspergillus can invade damaged respiratory tissue and, in severe cases, spread beyond the lungs. Preventive antifungal treatment is therefore frequently considered during the post-transplant period, particularly when clinicians judge that a patient’s exposure or medical condition creates an elevated risk.
Amphotericin B is a polyene antifungal drug that works by targeting ergosterol, a sterol found in fungal cell membranes. After binding to ergosterol, the drug can disrupt membrane integrity and cause leakage of cellular contents, ultimately killing the fungal cell. The same broad interaction with biological membranes helps explain why older amphotericin B formulations can damage human tissues, especially the kidneys. Patients may experience renal impairment, electrolyte disturbances, infusion-related reactions, or other complications that become particularly important after transplantation, when several medications already place stress on organ function.
Liposomal amphotericin B was developed to improve the drug’s delivery and tolerability. In this formulation, amphotericin B molecules are enclosed within microscopic lipid vesicles known as liposomes. The carrier changes the drug’s distribution in the body and can reduce the amount of free amphotericin B available to interact with human cell membranes. This does not eliminate toxicity, but it may create a more favorable balance between antifungal activity and safety. For transplant teams, that distinction is crucial: prophylaxis may be administered to prevent a potentially devastating infection, yet the preventive therapy itself must not compromise kidney function or interfere with recovery.
The study by Boscolo, Sella, Congedi and colleagues specifically addresses the safety of liposomal amphotericin B in patients undergoing bilateral lung transplantation. Rather than presenting the drug only as an antifungal strategy, the paper places emphasis on the clinical consequences of administering it to individuals whose physiology is already changing rapidly after surgery. A safety analysis can include medical events such as renal dysfunction, changes in serum electrolytes, infusion reactions, treatment discontinuation, and other adverse effects that may occur during prophylaxis. These outcomes help physicians determine whether the treatment is practical in routine transplant care.
Safety monitoring is especially complex in this setting because postoperative complications can have multiple causes. A rise in creatinine, for example, may reflect amphotericin exposure, dehydration, hemodynamic instability, infection, or the effects of other nephrotoxic drugs. Transplant recipients commonly receive calcineurin inhibitors such as tacrolimus, which themselves require careful monitoring because excessive exposure can injure the kidneys. Distinguishing drug-related toxicity from the consequences of surgery and critical illness is therefore a central challenge in evaluating antifungal prophylaxis.
The liposomal formulation may also influence how clinicians manage treatment around other immunosuppressive therapies. Although amphotericin B does not act on the same molecular targets as immunosuppressants, overlapping toxicities can narrow the margin of safety. Electrolyte losses, particularly involving potassium and magnesium, may increase the risk of cardiac or neuromuscular complications and can complicate the use of other medicines. Regular laboratory testing, fluid management, dose evaluation, and surveillance for infusion reactions are consequently essential components of care rather than optional additions.
The importance of this analysis extends beyond a single drug choice. Antifungal prophylaxis after lung transplantation is not a uniform process, and clinical centers may differ in their preferred agents, treatment duration, routes of administration, and criteria for identifying high-risk patients. Decisions can also be influenced by local fungal epidemiology, organ function, drug interactions, and the availability of therapeutic monitoring. Evidence focused on safety gives transplant specialists a clearer foundation for comparing liposomal amphotericin B with alternative preventive approaches, including azole antifungals, which carry their own risks of liver toxicity and interactions with immunosuppressive drugs.
The publication does not change the underlying reality that antifungal prevention must be individualized. A prophylactic drug can lower the likelihood of invasive fungal disease, but it cannot replace microbiological surveillance, imaging, clinical assessment, and rapid investigation of new respiratory symptoms. For patients with transplanted lungs, the central goal is to preserve the new organs while avoiding preventable harm from treatment. By examining liposomal amphotericin B through a safety-focused lens, the researchers contribute to a broader effort to make post-transplant care more predictable, measurable, and safer during one of the most vulnerable phases of recovery.
Subject of Research: The safety of liposomal amphotericin B used as antifungal prophylaxis in patients undergoing bilateral lung transplantation.
Article Title: Liposomal amphotericin B as an antifungal prophylaxis in bilateral lung transplantation: a safety analysis.
Article References: Boscolo, A., Sella, N., Congedi, S. et al. Liposomal amphotericin B as an antifungal prophylaxis in bilateral lung transplantation: a safety analysis. BMC Pharmacology and Toxicology (2026). https://doi.org/10.1186/s40360-026-01189-x
Image Credits: AI Generated
DOI: 10.1186/s40360-026-01189-x
Keywords: Liposomal amphotericin B, antifungal prophylaxis, bilateral lung transplantation, invasive fungal infection, drug safety, transplant medicine
